{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANCEL L DALTON","gend":0,"add":"117 WATER PLANT RD","city":"HILLSVILLE  ","state":"VA","zip":"24343-9998","dob":"1950-12-24","age":"","mstatus":"","insh":11009559,"cliId":"1NR7Y19XH67","pno":2767338407,"cno":2767338407,"email":"","ename":"","eno":"","pphy":"BUTLER, AMY ","ppno":2762365181,"pcpadd":"199 Hospital Dr Ste 7","pcpcity":"Galax ","pcpstate":"VA","pcpzip":243332453,"pcpcounty":"","pcpid":"P0117806","pcpname":"CARILION MEDICAL ASSOCIATES HILLSVILLE FAMILY","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"117 WATER PLANT RD","madd2":"","madd3":"","mcity":"HILLSVILLE  ","mstate":"VA","mzip":"24343-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","J44.9","Z72.0","F41.9","M13.80","N40.1","K21.9","Z23","Z00.00","Z12.5"],"date":["2021-06-11","2021-06-11","2020-08-11","2021-06-11","2021-06-11","2020-08-11","2020-08-11","2020-12-11","2020-12-11","2020-12-11"],"priorHcc":["","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","173085910","BREO ELLIPTA","INH 100-25","","Select","Select",""],["","68382041205","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","45963067796","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","59746038306","TERAZOSIN","CAP 1MG","","Select","Select",""],["","51672404601","ENALAPR\/HCTZ","TAB 10-25MG","","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","","Select","Select",""],["","54429725","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","378459710","METOPROLOL","TAB 100MG ER","","Select","Select",""],["","173087310","INCRUSE ELPT","INH 62.5MCG","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","173085910","BREO ","INH 100-25","60","Select","Select",""],["","45963067796","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","59746038306","TERAZOSIN ","CAP 1MG","30","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","51672404601","ENALAPR\/HCTZ ","TAB 10-25MG","30","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","29300022010","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","54429725","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","378459710","METOPROLOL ","TAB 100MG ER","30","Select","Select",""],["","173087310","INCRUSE ","INH 62.5MCG","30","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","45963067796","METOPROL","100MG ER","30","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173087310","INCRUSE","62.5MCG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}